Subcapsular versus total orchiectomy in advanced prostate cancer: A systematic review and meta-analysis of clinical and patient-reported outcomes.

Authors

Angga D M Pratama, Steven A Shenelo, Rizqi A F Kamila, Didit Pramudhito

Published in

Urologic oncology. Volume 44. Issue 9. Pages 243-255. Jun 27, 2026. Epub Jun 27, 2026.

Abstract

Prostate cancer (CaP) is a leading malignancy in men, frequently diagnosed at advanced stages where androgen deprivation therapy remains the standard treatment. Surgical castration, either subcapsular or total orchiectomy, offers a definitive and cost-effective approach to androgen deprivation therapy. This study systematically compares clinical and patient-reported outcomes between subcapsular and total orchiectomy in patients with advanced CaP.
A systematic search was conducted in PubMed, Scopus, and Cochrane Library through July 2025. Eligible studies included men with advanced CaP undergoing subcapsular or total orchiectomy. Risk of bias was assessed using RoB 2 for randomized trials and Newcastle-Ottawa Scale for nonrandomized studies. Data were analyzed using RevMan, and certainty of evidence was evaluated using GRADE approach.
Twelve studies involving 759 patients were included. Subcapsular orchiectomy was associated with significantly higher postoperative testosterone levels (mean difference = 4.03, 95% confidence intervals 2.78-5.28), higher prostate-specific antigen (PSA) levels (mean difference = 0.94; 95% CI 0.54-1.33), and greater treatment satisfaction (odds ratios = 3.78; 95% confidence intervals 1.98-7.19) compared to total orchiectomy. No significant differences were found in overall functional assessment of cancer therapy-prostate scores, including physical, social, emotional, and functional well-being domains, prostate cancer subscale, operative time, and luteinizing hormone levels.
Subcapsular orchiectomy may provide less effective hormonal and PSA suppression but greater treatment satisfaction, with comparable quality of life outcomes and operative time compared with total orchiectomy, suggesting a trade-off between biochemical suppression and patient-centered benefits.

PMID:
42364308
Bibliographic data and abstract were imported from PubMed on 28 Jun 2026.

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